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Home My WebLink About374454 ARTHUR J GALLAGHER RISK MGT SERVICES - CONTRACT - RFP - P1158 INUSRANCE (2)Administrative Services Purchasing Division April 28, 2009 Ms. Royanna G. Carle Marketing Director Berkley Risk Administrators Company, LLC & States Self -Insurers Risk Retention Group, Inc. 222 South 9th Street, Suite 1300 Minneapolis, MN 55402-3332 VIA E-MAIL: rcarle 20erklevrisk.com RE: CITY OF FORT COLLINS - 2009/10 INSURANCE PROGRAM LETTER OF AGREEMENT Dear Royanna: The City of Ft Collins, Poudre Fire Authority and Poudre Fire Protection District would like to confirm our agreement to bind the coverages you have proposed through States Self -insurers Risk Retention Group for twelve months effective May 1, 2009. ➢ Excess Liability Coverage including but not limited to: General Liability, Auto Liability, Law Enforcement Liability and Public Officials E & O as proposed. The agreement to bind coverage is based upon your compliance with the company's proposal, subsequent correspondence and this Letter of Agreement which outlines below those areas modified or needing additional clarification. The two attachments further clarify our understanding of your offering and form a part of this agreement. 1. You will endeavor to have copies of all policies provided to COFC within 90 days of the coverage effective date, if possible. 2. Premiums, limits, rates, deductibles and other provisions, including footnotes serving as a basis for this agreement are per Attachments I and Il, Cost and Coverage Comparisons, respectively. 3. All required binders, liability certificates (see certificate list attached) and auto ID cards will be issued prior to May 1, 2009, 235 Noi<'tgi �a46ftd$P1PBF'p0$hif'1ff6o�Y�t'.O. Box 580 • Fort Collins, CO 80527,0580 • (970) 221-6775 • FAX (970)221-6707 _121t. I � y/z cl113 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCF,COVERAGE You arc hereby notified that under the Terrorism Risk Insurance Act, as amended, (the "Act'), that you haven right to purchase insurance coverage for losses urising out ofacts of lerrorism,as definer(iu seclion 102(1) ofthe Act. The term "act of terrorism" means any act that is cern lied by the Secremry, ofTreasury -in concurrence with the Secretary of Slate and the Allomey Gmeml of the United States -to bean act of terrorism; to be a violent actor an act that is dangerous to human life, property; or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of an air carrier or vessel or the premises of United States mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to innucacc the policy or affect the conduct of the United States Government by coercian. Coverage under your X New or _ RENEWAL policy may be affected as follows: YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES RESUTA ING FROM CERrR:lED ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY'I HE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECTYOUR COVERAGE, SUCI I AS AN EXCLUSION FOR NUCLEAR EVENTS, UNDER THE FORMULA, TI IE UNITED STAPES GOVERNMEN'1'GENERALLY REIMBURSES 85% OF COVERED TERRORISM LOSSES EXCEEDING TI IE STATUTORILY ESTABLISI 1171) DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDINGTIIE COVERAGE. THE PRFM1UMCHARGED FORTHIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS THAT MAY BE COVERED BY THE FEDERAL GOVERNMENTUNDER THE ACT YOU SHOULD ALSO KNOW TI [A'I'Till: ACT, CONTAINS A $100 BILLION CAP TIIAT' LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURER'S LIABILITY FOR LOSSES RESUUrING 17ROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANYONE CALENDAR YEAR EXCEEDS $100 BILLION. IF TILE AGGREGATE INSURED LOSSES FOR ALI, INSURERS EXCEEDSI00 BILLION, YOUR COVERAGE MAYBE REDUCED. Acceutanee or Reiecdo , of Terrorism Ins. rnnce Coverane 1 hereby elect to purchase coverage, subject to the limitations of the Act, for acts of temxism, ns defined in the Act, fora premium of S4,961 I hereby decline coverage for terrorism. 1 understand that I will have no mvemge for losses resulting from acts of terrorism. City of Ft. Collins A anl/Named Insured By. Aut onz Rcpresenlativc's Signature `I Dal States RRG Insurance Company Authorized Representatives Title SEI,3017500 Policy Number Please indicate your choice above, sign where indicated, and return the original form to us at the address blow no later than We recomtmmd that you keep a copy of this notice for your records. States RRG c/o Berkley Risk Administrators Company 222 S Ninth St Sic 1300 Minneapolis, MN 55402-3332 States Self -Insurers Amended and Restated Trust Agreement Adopted November 1, 2000 Page 9 of 9 SIGNATURE PAGE Attaching To And Forming Part Of The STATES SELF -INSURERS TRUST AGREEMENT IN WITNESS of its acceptance of membership in the States Self -Insurers Trust (the "Trust") and commitment to the terms of the Amended and Restated States Self -Insurers Trust Agreement (the "Agreement") dated November 1, 2000 and any duly authorized amendments thereto, if any, each party to the Agreement (the "Member") has caused this Signature Page tobe executed by the Member's duly authorized officers or representatives. SIGNED IN I_li� -, a-r CO(. 4TsyJ W crtvicoUx .Srnre This LDay Of /t-4� .2 MEMBER ENTITY'S NAME: WVtE l=oCrCoLL.W1St t6vplaFf:�i2oAvyooeiay Af)-oz—ti(Zo t MEMBER ENTITY'S ADDRESS: 6�d6c�k S�� AUTHORIZED SIGNATURE: "` M_ Z_ (Attach Sea], if applicable) TYPED NAME OF SIGNA O ,�A✓t-t r V 1J 6. e_1_ ZE SIGNATURE OF WITNESS: /.,, TYPED NAME OF WITNESS: NAME OF MEMBER ENTITY'S AUTHORIZED REPRESENTATIVE TO THE TRUST: tA, `i , &_ v t 4'A4 G .rye. ACCEPTED BY:�`2:%i�� "�-- stGNMruaa ON BEHALF OF STATES SELF -INSURERS TRUST BY: Robert W. Esenberg, ARM ITS: President & CEO DATE: vB Administrative Services Purchasing Division April 28, 2009 Ms. Royanna G. Carle Marketing Director Berkley Risk Administrators Company, LLC & States Self -Insurers Risk Retention Group, Inc. 222 South 9th Street, Suite 1300 Minneapolis, MN 55402-3332 VIA E-MAIL: rcarle u,berkleyrisk.com RE: CITY OF FORT COLLINS - 2009/10 INSURANCE PROGRAM LETTER OF AGREEMENT Dear Royanna: The City of Ft Collins, Poudre Fire Authority and Poudre Fire Protection District would like to confirm our agreement to bind the coverages you have proposed through States Self -Insurers Risk Retention Group for twelve months effective May 1, 2009. i Excess Liability Coverage including but not limited to: General Liability, Auto Liability, Law Enforcement Liability and Public Officials E & O as proposed. The agreement to bind coverage is based upon your compliance with the company's proposal, subsequent correspondence and this Letter of Agreement which outlines below those areas modified or needing additional clarification. The two attachments further clarify our understanding of your offering and form a part of this agreement. 1. You will endeavor to have copies of all policies provided to COFC within 90 days of the coverage effective date, if possible. 2. Premiums, limits, rates, deductibles and other provisions, including footnotes serving as a basis for this agreement are per Attachments I and 1I, Cost and Coverage Comparisons, respectively. 3. All required binders, liability certificates (see certificate list attached) and auto ID cards will be issued prior to May 1, 2009. 215 Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6775 • FAX (970) 221-6707 Ms. Royanna Carle April 28, 2009 Page 2 4. We are aware that, States's efforts to review coverages and complete the coverage checklist represent an effort to inventory coverages. While the City understands that these are for illustration purposes and the actual policy language will prevail. We relied on these representations to analyze the bids received. These will form a basis for future review efforts of actual policies. Therefore, please take a look at these for accuracy. An actual policy review will be done after policy issuance. 5. This placement of coverage does not include us using a broker representative. We plan to work with States on a direct basis. Amended definition of Insured Contracts — Railroad coverage form will be added to the policy for general liability and automobile liability. If the terms of this Letter of Agreement are correct, please sign the letter returning the original to us with binders today. All binders need to reference this letter of agreement. Sincerely, Jame B. O'Neill II, CPPO, FNIGP Dir for of Purchasing and Risk Management Berkley Risk Administrators Company, LLC & States Self -Insurers Risk Retention Group, Inc. Signed: Enclosures Date cc: Mr. James Graham, Applied Risk Solutions Mr. Lance Murray, Risk Manager, City of Fort Collins M:\COFC\2003 Services\Correspondence\cov_agree_Itr_NG.doc